Urgent Cardiac Surgery for Patient With Floating Thrombus in the Left Ventricle

A 65-year-old patient was admitted to the Institute with complaints of shortness of breath, palpitation, and limb edema. Comorbidities were type 2 diabetes mellitus, gout, obesity. Echo: left ventricular ejection fraction 22%, left ventricular aneurysm (LVA), floating thrombus 5.5 × 2.35 cm, pulmonary hypertension. Ultrasound screening of the braсhiocephalic arteries revealed thrombotic occlusion of the right internal carotid artery that was confirmed by computed tomography study. Coronary angio: multivessel disease with left anterior descending artery occlusion. EuroSCORE II risk: 14.88%. Operation: coronary artery bypass graft with resection of LVA with thrombectomy (duration 6 hours, aortic cross-clamp 79 minutes, perfusion time 152 minutes). The patient was discharged on postoperative day 10. At the 5-month follow-up, the patient had no complaints, left ventricular ejection fraction 42%. This clinical case demonstrates successful surgical treatment of the patient with LVA with floating thrombus and thrombotic occlusion of the right internal carotid artery. The key to success in the treatment is careful planning of perioperative management by the heart team and stability of hemodynamic parameters.